Background: Hypocalcemia is the most common complication following total thyroidectomy. This study aimed to evaluate the efficacy of perioperative combined calcium and vitamin D supplementation compared to postoperative combined calcium and vitamin D supplementation in reducing symptomatic hypocalcemia. Materials and methods: A prospective randomized placebo-controlled trial was carried out in patients undergoing total or completion thyroidectomy from June 2017 to May 2022. Eligible patients were assigned to receive either calcium carbonate and alfacalcidol or placebo 3 days before surgery, and both groups were given calcium carbonate and alfacalcidol for 14 days after surgery. Clinical outcomes (signs and symptoms of hypocalcemia, requirement of intravenous calcium, and medication-induced hypercalcemia) and laboratory results (calcium and parathyroid hormone levels) were compared between the two groups. Results: One hundred and thirty-four patients were included in the analysis, 68 were in perioperative oral calcium and vitamin D supplementation group, and 66 were in postoperative oral calcium and vitamin D supplementation group. Symptomatic hypocalcemia rates were significantly lower in the perioperative group than in the postoperative group (8.8 and 22.7%, respectively, P=0.033). All symptomatic hypocalcemia cases in the perioperative group occurred in the first 24 hours after surgery. Mean calcium levels were significantly higher in the perioperative group at 24 and 48 hours after surgery. Intravenous calcium requirement rate was lower in the perioperative group but the difference was insignificant (2.9 and 12.1%, P=0.053). Mean parathyroid hormone levels were within the normal range and did not differ between groups. No medication-induced hypercalcemia was detected in either group. Conclusion: Perioperative oral calcium and vitamin D supplementation significantly decreased the risks of symptomatic and biochemical hypocalcemia compared to postoperative oral calcium and vitamin D supplementation. The perioperative supplementation also shortened the recovery period of symptomatic hypocalcemia to within 24 hours.

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Introduction Free flaps have been the preferred method for reconstruction after resection of oral cavity cancer. However, pedicled flaps remain valuable alternatives in appropriate settings. Objective The main objective of the present study was to compare surgical complications, hospital costs, and functional outcomes of oral cavity cancer patients who underwent soft tissue reconstruction with pedicled flaps or free flaps. Methods A total of 171 patients were included in the study. Ninety-eight underwent reconstruction with a pectoralis major, submental, temporalis, or supraclavicular pedicled flap, and in 73 patients, a radial forearm or anterolateral thigh free flap had been used. The cases were retrospectively reviewed, and a comparative analysis was carried out between the two groups. Results Recipient site and flap complications, speech, and swallowing functions did not differ between groups, but donor site complications, operative time, hospital stay, and costs were significantly reduced in the pedicled flap group compared with the free flap group. However, the pectoralis major flap reconstruction resulted in a more inferior swallowing function than the free flap reconstruction. Conclusions With comparable complications and functional outcomes, while decreasing in costs, pedicled flaps are a useful alternative to free flaps in oral cavity cancer reconstruction. However, in an extensive defect (> 70 cm2), free flaps are the reconstruction of choice for the preservation of swallowing function.

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Objectives: Parotidectomy increases childhood challenges. This study aimed to determine the clinical profiles, investigations, and outcomes of pediatric patients who had undergone parotidectomy.Methods: A multicenter retrospective review of parotidectomy in pediatric patients between 2007 and 2020.Results: In 108 parotidectomies, the final diagnoses were benign (47.22%), malignant (36.11%), and non-neoplastic (16.67%). The incidence of facial palsy was 37.03%, which was significantly lower in the superficial group than that in the total parotidectomy group (p = .021). The incidence of facial nerve palsy was significantly higher in the malignancy group than that in the benign group (p = .035). Magnetic resonance imaging (MRI) detected malignancy with 92.8% overall accuracy, 83.3% sensitivity, and 100% specificity. The sensitivity and specificity of fine-needle aspiration (FNA) were 54.2% and 92.7%, respectively.Conclusions: Parotidectomy is commonly performed for benign and non-neoplastic diseases in pediatric patients. Facial nerve palsy is significantly associated with malignant tumors and total parotidectomy. MRI is the most accurate imaging modality for diagnosing malignant lesions. FNA exhibits moderate agreement with the final pathology.

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Background: Dysphagia assessment using standard tools is not commonly performed in Thailand because it relies on equipment and experts to evaluate. This study was conducted by combining the Thai EAT-10 and the 3-ounce water swallow test, an easy-to-use tool for dysphagia screening. Therefore, it is crucial to study the accuracy and appropriateness before being widely used in the Thai population. Objectives: To evaluate the validity of the combined Thai Eating Assessment Tool 10 (Thai EAT-10) and the 3-ounce Water Swallow Test (WST) screening algorithm for detecting dysphagia compared to diagnosis by an otolaryngologist. Materials and methods: Analytical Cross-sectional study: sample of 260 adults (aged 20 years old or older) demographic data and past medical history were assessed using a questionnaire. The accuracy of dysphagia screening tests that combine Thai EAT-10 and the 3-ounce water swallow test with pulse oximetry was compared to the clinical swallow test assessed by an otolaryngologist. The sensitivity and specificity of the swallowing screening test for detecting dysphagia were evaluated. Results: Thai EAT-10 combined with the 3-ounce Water Swallow Test has higher validity and accuracy for dysphagia evaluation than those of the Thai EAT-10 or the 3-ounce Water Swallow Test alone. There was 100% sensitivity, 93.4% specificity, 68.1% positive predictive value (PPV), and 100% negative predictive value (NPV). Conclusion: The Thai EAT-10 combined with the 3-ounce water swallow test and pulse oximetry has higher reliability and validity than those of the Thai EAT-10 and the 3-ounce water swallow test alone. The reliability and validity of the combined test is closed to the gold standard. Furthermore, the algorithm is appropriate for screening dysphagia in remote areas with a large population.

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